Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Mail Code UH2, Portland, OR 97239, USA.
Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Mail Code UH2, Portland, OR 97239, USA.
Anesthesiol Clin. 2021 Mar;39(1):71-92. doi: 10.1016/j.anclin.2020.11.007.
Understanding how anesthetics impact cerebral physiology, cerebral blood flow, brain metabolism, brain relaxation, and neurologic recovery is crucial for optimizing anesthesia during supratentorial craniotomies. Intraoperative goals for supratentorial tumor resection include maintaining cerebral perfusion pressure and cerebral autoregulation, optimizing surgical access and neuromonitoring, and facilitating rapid, cooperative emergence. Evidence-based studies increasingly expand the impact of anesthetic care beyond immediate perioperative care into both preoperative optimization and minimizing postoperative consequences. New evidence is needed for neuroanesthesia's role in neurooncology, in preventing conversion from acute to chronic pain, and in decreasing risk of intraoperative ischemia and postoperative delirium.
了解麻醉如何影响大脑生理学、脑血流、脑代谢、脑松弛以及神经恢复，对于优化幕上开颅手术中的麻醉至关重要。幕上肿瘤切除术中的目标包括维持脑灌注压和脑自动调节、优化手术入路和神经监测，以及促进快速、协作的苏醒。基于证据的研究越来越多地扩大了麻醉护理的影响，不仅限于手术期间的护理，还包括术前优化和最小化术后后果。神经麻醉在神经肿瘤学中的作用、预防急性疼痛向慢性疼痛的转化、降低术中缺血和术后谵妄的风险方面，都需要新的证据。
